Provider Demographics
NPI:1942352455
Name:FABIAN-BURRIS, MELISSA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:FABIAN-BURRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12275 PHEASANT RUN CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-5679
Mailing Address - Country:US
Mailing Address - Phone:330-507-9397
Mailing Address - Fax:
Practice Address - Street 1:12275 PHEASANT RUN CIR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-5679
Practice Address - Country:US
Practice Address - Phone:330-507-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4204991Medicare ID - Type UnspecifiedPROVIDER NUMBER